Expand Ohio’s Medicaid expansion story

Keep people at the fore, but dig into the private insurance angle

DETROIT, MI — While reporters across the country are tackling the Medicaid expansion story as the Affordable Care Act takes effect, Ohio is one of a handful of states that has drawn national press attention. As Sarah Kliff wrote on March 13 for The Washington Post’s Wonkblog, Governor John Kasich surprised many health care observers by accepting the expansion, which could cover about 684,000 Ohioans, and including funding for it in his proposed 2014 budget. But the Republican-controlled Ohio legislature—on spring break through April 8—has yet to back Kasich. In the ongoing negotiations, one possibility has emerged that is novel enough to catch widespread notice: using the federal Medicaid expansion funds for private insurance coverage for low-income people.

As background: the federal government has approved Arkansas’s request for just this sort of compromise tactic, opening the door for at least four other states to mirror it—Ohio among them. This strategy raises a number of questions, particularly about the relative effectiveness of care under this plan, the impact of this approach on the Affordable Care Act as a whole, and the cost to federal taxpayers. According to The New York Times, the private insurance approach may be more expensive because it pays higher rates to health care providers compared to Medicaid rates. Nonetheless, as The Wall Street Journalreported last month, Gov. Kasich is pushing for such a deal—and Greg Moody, director of the Governor’s Office of Health Transformation, “said there were still many details to sort out, but ‘we’re very confident we can work through those things.’”

But while Ohio’s role in experimenting with private insurance coverage through Medicaid was elevated by national media throughout March, health care reporters within the state largely buried it in favor of spotlighting the potential human impact of Medicaid expansion. On March 17, Diane Suchetka in the Cleveland Plain Dealer wrote a lovely longform story focusing on the precarious experiences of Ohioans without health care, including a hair stylist who has been living with severe pain in her mouth for nearly a year, unable to afford a visit to the dentist. A March 21 article in The Columbus Dispatch focused on clergy who were agitating in favor of the expansion by carrying “fishes and loaves” to the Ohio House of Representatives.

Lisa Bernard-Kuhn wrote a solid story for the Cincinnati Enquirer on March 9 about the expansion efforts in both Ohio and Kentucky that included profiles of the people the political debate is ultimately about—those who can only get health care through emergency rooms, or who make too much to qualify for Medicaid themselves under the current system, but not enough to receive quality care.

This is good material that wisely keeps people at the center of the politics. At the same time, it is surprising that the private insurance angle did not receive a fuller treatment from the state’s major newspapers: it’s mentioned in passing at the end of the Enquirer story, as well as in this newsy March 14 piece in the Dispatch on opposition to the Medicaid expansion. This March 29 Dispatch piece focused on the “one GOP alternative to Medicaid expansion” that Kasich has “ruled out.” But otherwise, the state media did not focus on the issue, even as the national story took hold.

With an enormous amount of money, political prestige, and, lest we forget, people’s lives at stake, the Medicaid expansion story has many important threads. How are Ohio reporters deciding what to prioritize?

Sarah Jane Tribble, health reporter at the Plain Dealer, wrote in a recent email interview that, “Medicaid expansion offers a chance to weave the storyline of human needs with money and politics. The topic makes for a sexy story, if you will.” Nonetheless, she takes a pragmatic approach, imagining what her average readers would want to know—mindful that her readers include both those who may qualify for expanded Medicaid coverage as well as executives in the health care industry. “As for the most important thing for readers to understand, going forward? Right now, it might be as simple as letting them know that Gov. Kasich’s February announcement wasn’t the end of the conversation,” Tribble said.

Bernard-Kuhn, who shifted to the health care beat at the Cincinnati Enquirer in February after reporting on business, said that media outlets have a responsibility to report on the expansion as an ongoing story with clear impacts on readers. The Enquirer, she said, is interested in establishing itself as the go-to place for readers looking to understand health care reform in Ohio, and may soon have a landing page on its site dedicated this. It will feature “big stories as anchors and turn-of-the-screw coverage as we see fit, focusing on the Affordable Care Act and the Medicaid expansion,” she said.

One of the reasons for her paper’s delay on the “incredibly important” private insurance story, Bernard-Kuhn told me, was because so much of the story hinged on rumor: no proposal for a hybrid Medicaid/private insurance plan has officially emerged yet, and there are few facts to actually report. (Bernard-Kuhn did write an April 1 story that sketched out the details that do exist, hazy as they are.) “Until we see an amendment proposed,” she said, “we have no idea what details there are.”

For her part, the Plain Dealer’s Tribble said that putting too much weight on the private insurance story now risks devolving into political gossip. She wrote in an email:

In Ohio, it’s not at all surprising that the private insurance option is still on the table. Gov. Kasich’s administration indicated that it was during his February Medicaid announcement, saying that his folks had been on the phone with the White House about options. So, in a sense, it’s old news. Also the editors and writers at the Plain Dealer have been very careful to not take a political side on this issue. In many ways, that means waiting and seeing and watching for the real news—in contrast to writing about what people are talking about.

These are good points. And both Tribble and Bernard-Kuhn, as well as other Ohio journalists, are doing a nice job highlighting local voices and the potential local impact of Medicaid expansion. But, with all due caution for sticking to the facts, they should press forward on the private insurance angle, both as context for local stories and as straight-on news coverage, so long as it’s part of the Medicaid debate in the state legislature. Their unique access to Ohio legislators and lobbyists provides the opportunity—perhaps the responsibility—to push the story forward in useful ways by asking questions and examining potential influencers on politicians who are weighing the decision.

In short, they shouldn’t cede this story to reporters beyond their borders.

Tribble, for one, appears ready to go: “There are some great analysis stories to be done and you can expect to see more from me and others [at the Plain Dealer] after the lawmakers get back from spring break.”

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